Case 4

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September 21, 2021

Date of Admission-18-9-21

A 29 years old female presented to OPD with chief complaints of fever, cough, cold since 5 days.

HISTORY OF PRESENT ILLNESS 

Patient was apparently well 5 days back.

Patient complaints of generalised weakness,   dizziness since 5 days and shortness of breath, sweating since 2 days.

No history of dysphagia, loss of appetite, hypothyroidism, weight loss

HISTORY OF PAST ILLNESS 

Patient has history of gall bladder stone 6 years back undergone surgery.

Patient has history of uterus intramural fibroid at posterior upper body and fundamental part which was detected on USG 4 months back.

Patient was detected with minimal free fluid in post operative delirium region which suggests pelvic inflammatory disease 4 months back.

Patient was detected with grade 1 and grade 2 fatty liver.

No history of hypertension, CAD, tuberculosis, asthma.

PERSONAL HISTORY 

Diet- mixed

Appetite-normal

Sleep-adequate

Bowel and bladder movement-regular

No addictions

FAMILY HISTORY 

Patient complaint that her father is hypertensive.

TREATMENT HISTORY 

Patient consumes metformin 500mg twice daily since 2 years. 

MENSTRUAL HISTORY 

Patient has 30 days cycle with regular flow for 4 days.

Maternal status-Patient got married at the the age of 14 and has 3 children.

GENRAL EXAMINATION 

Patient is conscious,coherent, co-operative and well oriented to time and place 

There is no sign of pallor,oedema of left foot

There is no sign of cynosis,lymphadenopathy.

VITALS

Temperature-94.6 degree F

Pulse rate-103 per min

Respiratory rate-38 per min

Spo2-98

SYSTEMIC EXAMINATION 

Cardiovascular System 

Thrills-No

Cardiac sound-S1 and S2

Cardiac murmers-No

Respiratory System 

Dysnoea-No

Wheeze-No

Position of trachea-central

Breathe sound-vesicular

Abdomen

Shape-scaphoid

Tenderness-No

Palpable mass-No

Free fluid-No

Bruits-No

Liver and spleen-not palpable 

Bowel sounds-No

Central Nervous System 

Patient is conscious 

Speech-normal

Meningitis irritation-No

PROVISIONAL DIAGNOSIS 

Pyrexia decreased evaluation with diabetes mellitus type 2

INVESTIGATION 

TREATMENT 

Day 1

IV FLUIDS:

Normal saline @100mL/L

Ringer lactate solution@ 100mL/L

Tab.PCM 650mg PO/SOS

Inj.OPTINEURON 1amp in normal saline @100 mL/L

Inj.PAN 40 mg/PO/OP

Blood pressure , pulse rate , SpO2 monitoring. 

Tab.GLIMI -M1PO/OD.

Day 2

IV FLUIDS:

Normal saline @100mL/L

Ringer  lactate solution@  100mL/L

Tab.PCM 650mg PO/SOS

Inj.OPTINEURON 1amp in normal saline @100 mL/L

Inj.PAN 40 mg/PO/OP

Blood pressure , pulse rate , SpO2 monitoring. 

Tab.GLIMI -M1PO/OD.

 Tab.Levocetrizine 5mg/PO/HS.

Tab.Clonazepam 0.25mg/PO/HS.

Day 3

 IV FLUIDS:

Normal saline @100mL/L

Ringer  lactate solution@  100mL/L

Tab.PCM 650mg PO/SOS

Inj.OPTINEURON 1amp in normal saline @100 mL/L

Inj.PAN 40 mg/PO/OP

Blood pressure , pulse rate , SpO2 monitoring. 

Tab.GLIMI -M1 PO/OD.

 Tab.Levocetrizine 5mg/PO/HS.

Tab.Clonazepam 0.25mg/PO/HS.

What is Pyrexia?

Pyrexia is grouping of many unrelated medical condition that share the feature of persistent unexplained fever despite basic investigation.

Main stages of the molecular basis of pyrexia-:

Causes of Pyrexia- bacterial infection, viral infection, malignancy, autoimmune 

Pathophysiology of diabetes mellitus and infections-: